A COMPARISON OF COMBINED RECTAL MISOPROSTOL AND OXYTOCIN WITH OXYTOCIN ALONE IN THE CONTROL OF BLOOD LOSS DURING ELECTIVE CAESAREAN SECTION: A RANDOMISED CONTROLLED TRIAL
With the rise in Caesarean section rate in many obstetric centres worldwide, control of blood loss during this procedure is of great importance in order to prevent post partum haemorrhage (PPH). Oxytocin is commonly used drug for this purpose but due to problems such as cost and storage especially in developing countries, there is a need to seek other alternatives. Misoprostol may be considered on account of its good uterine contractility and relatively lower cost among others.
The main objective of this study was to compare the effectiveness of the drug regimen of rectally administered misoprostol and oxytocin with oxytocin alone in control of blood loss during Caesarean delivery up to 24 hours after delivery.
The study was a randomised controlled trial involving parturients that had elective Caesarean section at the University of Ilorin Teaching Hospital. They were grouped into two arms. One of the arms had 600μg of misoprostol inserted per rectum while the other arm received 20IU of oxytocin infusion for 4 hours after delivery. Both of the arms had 5IU of oxytocin administered within one minute of delivery of the baby. Intraoperative and postoperative blood loss up to 24hours after delivery, pre and postoperative haematocrit and side effects profiles of the two arms were recorded. Data analysis was done using Statistical Package for Social Sciences software (SPSS) version 21 and a p value set as 0.05 as the level of significance.
The mean intra operative blood loss was less in the combined oxytocin and misoprostol group than in the oxytocin group (550.59 ± 170.54ml versus and 585.07± 163.44 ml, p=0.208). Participants in the misoprostol group had a lower mean change in haematocrit level 3.58±1.80 versus 3.72±1.61 in the oxytocin alone group respectively. The need for additional oxytocics was more in the oxytocin group than in the misoprostol group (29.3% versus 26.7%). Blood transfusion was needed more in the oxytocin group than in the misoprostol group (5.3% versus 1.3%). Shivering and fever were significantly more common in the misoprostol group (p =0.02 and p =0.002 respectively). This was however transient and self limiting.
CONCLUSION: Pre delivery rectal misoprostol in addition to bolus oxytocin was comparable to oxytocin bolus and oxytocin infusion currently used in my centre for the control of blood loss during and after CS.
RECOMMENDATION: Pre delivery rectal misoprostol and bolus oxytocin is an alternative to oxytocin bolus and oxytocin infusion for the prevention of primary PPH during and after Caesarean section.